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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cspan style=\"font-weight: 400\">Gov. Gavin Newsom has been talking a big game about CARE (Community Assistance, Recovery and Empowerment) Court, the state’s new plan for treating people with severe mental illness. CARE Court, which every county in California will have to implement by next year, focuses on steering people suffering from severe psychosis, such as schizophrenia, and addiction into treatment. It will allow first responders, family members, clinicians and others to ask a judge to order treatment plans for unhoused people with severe psychotic disorders.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">San Francisco is gearing up to launch this program by Oct. 1. Can CARE Court actually deliver what the governor promises?\u003c/span>\u003c/p>\n\u003cp>\u003ca href=\"https://bit.ly/42AlWVW\">\u003cem>Episode transcript\u003c/em>\u003c/a>\u003c/p>\n\u003cp>\u003cb>Guest: \u003c/b>\u003ca href=\"https://twitter.com/scottshafer\">\u003cspan style=\"font-weight: 400\">Scott Shafer\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, senior editor of KQED’s Politics and Government Desk\u003c/span>\u003c/p>\n\u003cp id=\"embed-code\" class=\"inconsolata\">\n\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" frameborder=\"0\" height=\"200\" scrolling=\"no\" src=\"https://playlist.megaphone.fm/?e=KQINC5972549195&light=true\" width=\"100%\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Half a century after California policymakers \u003ca href=\"https://www.pbs.org/wgbh/pages/frontline/shows/asylums/special/excerpt.html\">shuttered\u003c/a> state psychiatric institutions, denouncing them as inhumane, today’s progressive leaders are now reconsidering involuntary commitments, saying not helping people who are seriously ill, and living in squalor on the streets, is inhumane.\u003c/p>\n\u003cp>The shift is pitting liberals against liberals over the very meaning of compassion. Disability rights advocates say the renewed push for forced treatment violates people’s civil rights, while Democratic leaders and doctors counter that doing nothing violates people’s right to medical care, particularly when the nature of their illness prevents them from recognizing they need help. [pullquote align='right' citation='State Sen. Scott Wiener']‘It is neither progressive nor compassionate to just sit by and let people deteriorate, fall apart and ultimately die on our streets. That is the opposite of progressive.’[/pullquote]\u003c/p>\n\u003cp>“The status quo has forced too many of our loved ones to die with their rights on,” said Teresa Pasquini, an advocate whose son has schizophrenia and has spent the past 20 years being “failed, jailed, treated, and streeted” by what she calls a broken public health system.\u003c/p>\n\u003cp>\u003ca href=\"https://www.huduser.gov/portal/sites/default/files/pdf/2022-AHAR-Part-1.pdf\">Half of the country’s unsheltered (PDF)\u003c/a> people live in California, and though only a quarter of them have a serious mental illness, state lawmakers say they need more tools to get people into treatment, even if it’s against their will. One proposal aims to expand who qualifies for a yearlong conservatorship, or involuntary psychiatric hold, while a new system of \u003ca href=\"https://www.kqed.org/news/11924117/governors-care-court-plan-passes-assembly-clearing-way-to-become-law\">CARE Courts\u003c/a>, where judges issue treatment plans, are scheduled to roll out in eight counties this fall. [pullquote align='right' citation='Keris Myrick']‘When people are told that they have to go to court to get what they should be getting voluntarily in the community, and then they get a care plan that subjugates them to services that still do not meet their cultural needs, that is not compassion.’[/pullquote]\u003c/p>\n\u003cp>To opponents, California is reverting to a draconian policy of locking people up just for being sick, but psychiatrists argue they are seeking a modest update to \u003ca href=\"https://www.lacourt.org/division/mentalhealth/MH0017.aspx\">a 56-year-old law\u003c/a>. Without more intervention options, they say, patients will continue to cycle into the emergency room and back to the street.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“We are doctors who have to watch these people die,” said Dr. Emily Wood of the\u003ca href=\"https://www.calpsychiatrists.org/\"> California State Association of Psychiatrists\u003c/a>, a sponsor of the conservatorship bill,\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202320240SB43\"> SB 43\u003c/a>. “We have to talk to their families who know that they need that care, and we have to say we don’t have any legal basis to bring them into the hospital right now.”\u003c/p>\n\u003cp>Under current state law, a person can be held in the hospital involuntarily if they are a danger to themselves or others, or if they are unable to seek food, clothing or shelter as a result of mental illness or alcoholism. Doctors want to incorporate substance use disorder into the law and include in the criteria the inability to look out for one’s own safety and medical care. (Mental health conservatorship is separate from the \u003ca href=\"https://www.scscourt.org/self_help/probate/conservatorship/conservatorship_overview.shtml\">probate conservatorship\u003c/a> that Brittney Spears was held under.)\u003c/p>\n\u003cp>Dr. Wood, who practices in Los Angeles, gave two examples of people she and her colleagues tried to care for, but who slipped through the cracks under the current rules: a man didn’t take his diabetes medication because he wasn’t taking his schizophrenia medication and didn’t understand the consequences of not managing either condition. He repeatedly ended up in the ER with dangerously high blood sugar, but no one could compel him to take either medication, because poorly managing one’s health is not a trigger for conservatorship.\u003c/p>\n\u003cp>Another man had a developmental disability that was never treated in childhood and developed an addiction to methamphetamine in his 20s. He’s now regularly found sleeping in a park and acting inappropriately in public. His family begged doctors to treat him, but they can’t because drug misuse is not a trigger for conservatorship.\u003c/p>\n\u003cp>To Dr. Wood, treating these people, even when they’re unable to consent, is the compassionate, moral thing to do.\u003c/p>\n\u003cp>“It’s essential that we respect all the rights of our patients, including the right to receive care from us,” she said.\u003c/p>\n\u003cp>But other advocates and people with mental illness see the issue very differently. Lawyers from the nonprofit \u003ca href=\"https://www.disabilityrightsca.org/\">Disability Rights California\u003c/a> say the expansion of conservatorship and the advance of CARE Courts are misguided, focused on depriving people of their liberty and privacy, instead of investing in better voluntary mental health services that maintain people’s dignity and civil rights. The group filed a lawsuit to try \u003ca href=\"https://www.disabilityrightsca.org/press-release/disability-rights-advocates-file-petition-challenging-the-constitutional-validity-of\">to block the implementation\u003c/a> of CARE Courts.\u003c/p>\n\u003cp>They’re concerned that people of color, specifically Black residents who are overrepresented in the homeless population and \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4274585/\" target=\"_blank\" rel=\"noopener\">overdiagnosed\u003c/a> with schizophrenia, will be disproportionately targeted by these more forceful measures.\u003c/p>\n\u003cp>“When people are told that they have to go to court to get what they should be getting voluntarily in the community, and then they get a care plan that subjugates them to services that still do not meet their cultural needs, that is not compassion,” said Keris Myrick, an advocate who has schizophrenia and has experienced homelessness.\u003c/p>\n\u003cp>Opponents’ other main objection is focused on capacity. Once people are compelled into treatment, where in the overextended, understaffed public mental health system are they supposed to go? Already, there aren’t enough psychiatric hospital beds or appropriate substance abuse centers or housing options for the people who need them, said Michelle Doty Cabrera, executive director of the \u003ca href=\"https://www.cbhda.org/\">California Behavioral Health Directors Association\u003c/a>.\u003c/p>\n\u003cp>“Expanding conservatorships doesn’t solve for those structural issues around the lack of housing and the lack of funding for treatment services,” she said.\u003c/p>\n\u003cp>Cabrera’s group also questions the premise that forced treatment works. Especially when it comes to substance use disorder,\u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/26790691/\"> research suggests\u003c/a> compulsory treatment is less effective and could even be harmful, elevating overdose risk. In Massachusetts, people who were involuntarily committed for drug treatment\u003ca href=\"https://www.mass.gov/service-details/chapter-55-overdose-report\"> were twice as likely to die\u003c/a> from an overdose as those who received treatment willingly.\u003c/p>\n\u003cp>More broadly, if the ultimate goal of forced treatment is reducing homelessness — and easing the moral heartbreak of witnessing ill people sleeping on the street or using drugs in the open — then lawmakers are writing the wrong prescription, some researchers say.\u003c/p>\n\u003cp>“The problem of homelessness is that people don’t have housing,” said Dr. Margot Kushel, director of the UCSF’s\u003ca href=\"https://homelessness.ucsf.edu/\"> Benioff Homelessness and Housing Initiative\u003c/a>. “If you had all the treatment in the world and you didn’t have the housing, we would still have this problem.”\u003c/p>\n\u003cp>She compares homelessness to a game of musical chairs, where the kid on crutches is the one left standing when the music stops. In California, there are \u003ca href=\"https://nlihc.org/gap\">24 units of affordable housing\u003c/a> for every 100 very low-income households, she said, and people with mental illness or substance use disorder are the ones who have the hardest time competing for those scarce spots. That’s why they’re overrepresented among the homeless population, she said, not because conservatorship laws aren’t strong enough.\u003c/p>\n\u003cp>“If you try to fix the problem of homelessness by tinkering with the health care system, we’re not going to get anywhere,” Kushel said.\u003c/p>\n\u003cp>Supporters of involuntary commitments say both are needed: treatment and housing. The same lawmakers who are backing expanded conservatorship and CARE Courts are also backing efforts to increase the housing supply, including \u003ca href=\"https://www.gov.ca.gov/2023/03/19/governor-newsom-proposes-modernization-of-californias-behavioral-health-system-and-more-mental-health-housing/\">a $3 billion bond measure\u003c/a> for the construction of small, neighborhood-oriented residences for people with mental illness.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“They need housing, but they need additional support so that they can thrive,” said Sen. Scott Wiener. “It is neither progressive nor compassionate to just sit by and let people deteriorate, fall apart and ultimately die on our streets. That is the opposite of progressive.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“We are doctors who have to watch these people die,” said Dr. Emily Wood of the\u003ca href=\"https://www.calpsychiatrists.org/\"> California State Association of Psychiatrists\u003c/a>, a sponsor of the conservatorship bill,\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202320240SB43\"> SB 43\u003c/a>. “We have to talk to their families who know that they need that care, and we have to say we don’t have any legal basis to bring them into the hospital right now.”\u003c/p>\n\u003cp>Under current state law, a person can be held in the hospital involuntarily if they are a danger to themselves or others, or if they are unable to seek food, clothing or shelter as a result of mental illness or alcoholism. Doctors want to incorporate substance use disorder into the law and include in the criteria the inability to look out for one’s own safety and medical care. (Mental health conservatorship is separate from the \u003ca href=\"https://www.scscourt.org/self_help/probate/conservatorship/conservatorship_overview.shtml\">probate conservatorship\u003c/a> that Brittney Spears was held under.)\u003c/p>\n\u003cp>Dr. Wood, who practices in Los Angeles, gave two examples of people she and her colleagues tried to care for, but who slipped through the cracks under the current rules: a man didn’t take his diabetes medication because he wasn’t taking his schizophrenia medication and didn’t understand the consequences of not managing either condition. He repeatedly ended up in the ER with dangerously high blood sugar, but no one could compel him to take either medication, because poorly managing one’s health is not a trigger for conservatorship.\u003c/p>\n\u003cp>Another man had a developmental disability that was never treated in childhood and developed an addiction to methamphetamine in his 20s. He’s now regularly found sleeping in a park and acting inappropriately in public. His family begged doctors to treat him, but they can’t because drug misuse is not a trigger for conservatorship.\u003c/p>\n\u003cp>To Dr. Wood, treating these people, even when they’re unable to consent, is the compassionate, moral thing to do.\u003c/p>\n\u003cp>“It’s essential that we respect all the rights of our patients, including the right to receive care from us,” she said.\u003c/p>\n\u003cp>But other advocates and people with mental illness see the issue very differently. Lawyers from the nonprofit \u003ca href=\"https://www.disabilityrightsca.org/\">Disability Rights California\u003c/a> say the expansion of conservatorship and the advance of CARE Courts are misguided, focused on depriving people of their liberty and privacy, instead of investing in better voluntary mental health services that maintain people’s dignity and civil rights. The group filed a lawsuit to try \u003ca href=\"https://www.disabilityrightsca.org/press-release/disability-rights-advocates-file-petition-challenging-the-constitutional-validity-of\">to block the implementation\u003c/a> of CARE Courts.\u003c/p>\n\u003cp>They’re concerned that people of color, specifically Black residents who are overrepresented in the homeless population and \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4274585/\" target=\"_blank\" rel=\"noopener\">overdiagnosed\u003c/a> with schizophrenia, will be disproportionately targeted by these more forceful measures.\u003c/p>\n\u003cp>“When people are told that they have to go to court to get what they should be getting voluntarily in the community, and then they get a care plan that subjugates them to services that still do not meet their cultural needs, that is not compassion,” said Keris Myrick, an advocate who has schizophrenia and has experienced homelessness.\u003c/p>\n\u003cp>Opponents’ other main objection is focused on capacity. Once people are compelled into treatment, where in the overextended, understaffed public mental health system are they supposed to go? Already, there aren’t enough psychiatric hospital beds or appropriate substance abuse centers or housing options for the people who need them, said Michelle Doty Cabrera, executive director of the \u003ca href=\"https://www.cbhda.org/\">California Behavioral Health Directors Association\u003c/a>.\u003c/p>\n\u003cp>“Expanding conservatorships doesn’t solve for those structural issues around the lack of housing and the lack of funding for treatment services,” she said.\u003c/p>\n\u003cp>Cabrera’s group also questions the premise that forced treatment works. Especially when it comes to substance use disorder,\u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/26790691/\"> research suggests\u003c/a> compulsory treatment is less effective and could even be harmful, elevating overdose risk. In Massachusetts, people who were involuntarily committed for drug treatment\u003ca href=\"https://www.mass.gov/service-details/chapter-55-overdose-report\"> were twice as likely to die\u003c/a> from an overdose as those who received treatment willingly.\u003c/p>\n\u003cp>More broadly, if the ultimate goal of forced treatment is reducing homelessness — and easing the moral heartbreak of witnessing ill people sleeping on the street or using drugs in the open — then lawmakers are writing the wrong prescription, some researchers say.\u003c/p>\n\u003cp>“The problem of homelessness is that people don’t have housing,” said Dr. Margot Kushel, director of the UCSF’s\u003ca href=\"https://homelessness.ucsf.edu/\"> Benioff Homelessness and Housing Initiative\u003c/a>. “If you had all the treatment in the world and you didn’t have the housing, we would still have this problem.”\u003c/p>\n\u003cp>She compares homelessness to a game of musical chairs, where the kid on crutches is the one left standing when the music stops. In California, there are \u003ca href=\"https://nlihc.org/gap\">24 units of affordable housing\u003c/a> for every 100 very low-income households, she said, and people with mental illness or substance use disorder are the ones who have the hardest time competing for those scarce spots. That’s why they’re overrepresented among the homeless population, she said, not because conservatorship laws aren’t strong enough.\u003c/p>\n\u003cp>“If you try to fix the problem of homelessness by tinkering with the health care system, we’re not going to get anywhere,” Kushel said.\u003c/p>\n\u003cp>Supporters of involuntary commitments say both are needed: treatment and housing. The same lawmakers who are backing expanded conservatorship and CARE Courts are also backing efforts to increase the housing supply, including \u003ca href=\"https://www.gov.ca.gov/2023/03/19/governor-newsom-proposes-modernization-of-californias-behavioral-health-system-and-more-mental-health-housing/\">a $3 billion bond measure\u003c/a> for the construction of small, neighborhood-oriented residences for people with mental illness.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“They need housing, but they need additional support so that they can thrive,” said Sen. Scott Wiener. “It is neither progressive nor compassionate to just sit by and let people deteriorate, fall apart and ultimately die on our streets. That is the opposite of progressive.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>\u003cb>Oakland Writers Ayodele Nzinga and Leila Mottley\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">This week, we welcome two contemporary Oakland authors: Leila Mottley and Dr. Ayodele Nzinga. Mottley is an Oakland Youth Poet Laureate, who at just 19 years old published “Nightcrawling” — an immersive novel and an Oprah’s Book Club selection — based on local events. She’s joined by Oakland’s inaugural Poet Laureate, Dr. Ayodele Nzinga, who shines not only as an author but also as a director, actor and educator. \u003c/span>\u003c/p>\n\u003cp> \u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Guests:\u003c/span>\u003c/p>\n\u003cul>\n\u003cli style=\"font-weight: 400\">\u003cspan style=\"font-weight: 400\">Leila Mottley, “Nightcrawling” author\u003c/span>\u003c/li>\n\u003cli style=\"font-weight: 400\">\u003cspan style=\"font-weight: 400\">Ayodele Nzinga, Oakland Poet Laureate\u003c/span>\u003c/li>\n\u003c/ul>\n\u003cp> \u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cb>This Week in California News and Politics\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">San Francisco Mayor London Breed, together with San Francisco Police Chief Bill Scott and San Francisco District Attorney Brooke Jenkins, announced a renewed push to prosecute drug dealers while also helping people dealing with substance use disorder. We talk with \u003c/span>\u003cb>Scott Shafer,\u003c/b> \u003cb>KQED politics and government senior editor\u003c/b>\u003cspan style=\"font-weight: 400\">, who spoke with Mayor Breed this week.\u003c/span>\u003c/p>\n\u003cp> \u003c/p>\n\u003cp>\u003cb>Something Beautiful: West Oakland Mural Project\u003c/b>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The West Oakland Mural Project highlights the vital role women played in the revolutionary Black Panther Party.\u003c/span>\u003c/p>\n\n",
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"description": "Oakland Writers Ayodele Nzinga and Leila Mottley This week, we welcome two contemporary Oakland authors: Leila Mottley and Dr. Ayodele Nzinga. Mottley is an Oakland Youth Poet Laureate, who at just 19 years old published "Nightcrawling" — an immersive novel and an Oprah's Book Club selection — based on local events. She's joined by Oakland's inaugural Poet Laureate, Dr. Ayodele Nzinga, who shines not only as an author but also as a director, actor and educator. Guests: Leila Mottley, "Nightcrawling" author Ayodele Nzinga, Oakland Poet Laureate This Week in California News and Politics San Francisco Mayor London Breed,",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cb>Oakland Writers Ayodele Nzinga and Leila Mottley\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">This week, we welcome two contemporary Oakland authors: Leila Mottley and Dr. Ayodele Nzinga. Mottley is an Oakland Youth Poet Laureate, who at just 19 years old published “Nightcrawling” — an immersive novel and an Oprah’s Book Club selection — based on local events. She’s joined by Oakland’s inaugural Poet Laureate, Dr. Ayodele Nzinga, who shines not only as an author but also as a director, actor and educator. \u003c/span>\u003c/p>\n\u003cp> \u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Guests:\u003c/span>\u003c/p>\n\u003cul>\n\u003cli style=\"font-weight: 400\">\u003cspan style=\"font-weight: 400\">Leila Mottley, “Nightcrawling” author\u003c/span>\u003c/li>\n\u003cli style=\"font-weight: 400\">\u003cspan style=\"font-weight: 400\">Ayodele Nzinga, Oakland Poet Laureate\u003c/span>\u003c/li>\n\u003c/ul>\n\u003cp> \u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"title": "Newsom Signs 'CARE Court' Plan, Overhauling Mental Health Care in California",
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"content": "\u003cp>\u003cem>Updated Wednesday 2 p.m.\u003c/em>\u003c/p>\n\u003cp>Gov. Gavin Newsom signed a controversial bill Wednesday overhauling the state’s approach to mental health care for people diagnosed with schizophrenia and other psychotic disorders.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The state Senate last month approved the\u003c/span> Community Assistance, Recovery and Empowerment Act, which will allow family members and first responders to ask a judge to draw up a treatment plan for people deemed to be suffering from those disorders. Those who refuse could be placed under a conservatorship and ordered to comply.\u003c/p>\n\u003cp>Currently, unhoused people with severe mental health disorders can be held against their will at psychiatric hospitals, but must be released after three days if they promise to follow up with other services and take prescribed medication.\u003c/p>\n\u003cp>The new law will let a court order a treatment plan for up to two years, which may include medication, housing and therapy.\u003cspan style=\"font-weight: 400\"> Participants will have access to a public defender and an advocate to help make decisions about treatment programs and housing. In turn, the behavioral health department in that county would be compelled to provide treatment.\u003c/span>\u003c/p>\n\u003cp>While it shares some elements of mental health programs in some other states, California’s new system will be the first of its kind in the country, according to state Sen. Tom Umberg, D-Santa Ana, who co-authored the law.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Standing outside Momentum for Health, a nonprofit mental health care provider in San José, Newsom on Wednesday said the bill was about redesigning a broken system \u003c/span>\u003cspan style=\"font-weight: 400\">that often leaves people cycling among homelessness, jail and emergency rooms. \u003c/span>\u003c/p>\n\u003cp>“I’m not interested in the status quo,” he said. “I’m not interested in the compassionless-ness of the approach we have today of people moralizing and normalizing that suffering on the streets and sidewalks.”\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But critics of the bill say it coerces people into care, which is less effective than voluntary treatment, and doesn’t provide the necessary health and housing resources.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">James Burch, deputy director of the Anti Police-Terror Project, which is part of a statewide coalition opposing CARE Court, called the bill’s signing “devastating.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“It ignores the very stark reality that we’re living in in this moment,” he said. “We are tens of thousands of beds short in the Bay Area of the permanent housing that we need. … And we are woefully short on voluntary treatment programs.”\u003c/span>\u003c/p>\n\u003cp>[aside postID=news_11914873 hero='https://ww2.kqed.org/app/uploads/sites/10/2022/05/RS16522_GettyImages-73453883-qut-1020x682.jpg']\u003cspan style=\"font-weight: 400\">Gov. Gavin Newsom introduced the proposal in March. \u003c/span>It passed the Legislature with overwhelming support, despite vehement opposition from disability rights and homeless advocates.\u003c/p>\n\u003cp>“It was just a matter of months ago that we stood right here and we laid out a vision,” Newsom said Wednesday. “And here we are. We’ve made it a reality, and that is rare in politics, particularly on issues as vexing and challenging as this issue.”\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Santa Clara County Superior Court Judge Stephen Manley said every day he sees people caught in a cycle of homelessness, jail and emergency rooms, without ever getting the adequate care or housing they need. Manley oversees a \u003ca href=\"https://steinberginstitute.org/champion/stephen-v-manley/\" target=\"_blank\" rel=\"noopener noreferrer\">mental health care diversion court\u003c/a> for people awaiting trial for suspected crimes. \u003c/span>\u003c/p>\n\u003cp>“I think this is a major step towards building a system that is going to be effective, as opposed to the present system,” Manley said, “where these individuals simply cycle through our jails over to the emergency room of a hospital, back to the streets, back to the jail, back to the hospital. And it doesn’t stop.”\u003c/p>\n\u003cp>Assemblymember Suzette Martinez Valladares, R-Santa Clarita, said CARE Court was coming 10 years too late. She shared the story of her cousin, a Vietnam veteran, who was homeless and living in an encampment for five years before he died.\u003c/p>\n\u003cp>“I wish that my family had the tools that this bill is going to bring forward so that he might still be alive and with us,” she said, adding, “But there’s more work to be done. This bill is great, but we need resources for the programs, for the services, for the workforce that doesn’t currently exist.”\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The state faces a shortage of not only \u003c/span>\u003ca href=\"https://www.rand.org/pubs/research_reports/RRA1824-1-v2.html\">\u003cspan style=\"font-weight: 400\">psychiatric facilities\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, but also the \u003c/span>\u003ca href=\"https://healthforce.ucsf.edu/sites/healthforce.ucsf.edu/files/publication-pdf/California%E2%80%99s%20Current%20and%20Future%20Behavioral%20Health%20Workforce.pdf\">\u003cspan style=\"font-weight: 400\">health care staff\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> needed to operate those facilities. And Newsom’s administration estimates that between 7,000 and 12,000 people across the state will be eligible for CARE Court. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“We’re guessing there will be demand for this,” said Michelle Doty Cabrera, executive director of the County Behavioral Health Directors Association of California. “There’s not a lot of give in terms of our workforce currently.”\u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The state is allocating $65 million to implement CARE Court within the judicial system, as well as additional money for county behavioral health care agencies, which would manage cases. To help pay for start-up and training costs, the first seven counties to implement CARE Court will receive $26 million, with another $31 million going to counties across the state, Doty Cabrera said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Those first seven counties are Glenn, Orange, Riverside, San Diego, Stanislaus, Tuolumne and San Francisco, which will implement CARE Courts by Oct. 1, 2023. The remaining counties would have until Dec. 1, 2024.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“And, there’s an ongoing conversation around long-term funding,” Doty Cabrera said. The bill now requires the state to provide funding to county behavioral health care agencies for programs and services before counties are required to implement CARE Court. “What that is, what it looks like, how much — all of that is still to be worked out between counties and the state,” she said.\u003c/span>\u003c/p>\n\u003cp>[aside postID=news_11916040 hero='https://ww2.kqed.org/app/uploads/sites/10/2022/02/GettyImages-1236267426-1020x680.jpg']The other looming question is housing. \u003cspan style=\"font-weight: 400\">The current version of the bill allows judges to order other government agencies, such as housing authorities, to prioritize CARE Court participants for housing. But in more rural parts of the state, housing with the appropriate services just doesn’t exist, Doty Cabrera added. \u003c/span>\u003c/p>\n\u003cp>“Who exactly are we going to pull into the order?” she said. “No one. There is nothing.”\u003c/p>\n\u003cp>Last year, nearly 14,000 people experiencing homelessness voluntarily sought mental health services, but only half were placed into housing, according to a survey conducted earlier this year by the County Behavioral Health Directors Association of California.\u003c/p>\n\u003cp>Beyond the logistics, members of the Assembly grappled with CARE Court’s reliance on the judicial system. Although voluntary, the legislation also comes with a threat: Continued refusal could be used as a justification for conservatorship, where people could be forced into care against their will.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“At what point does compassion end and our desire to just get people off the streets and out of public sight begin?” said Assemblymember Al Muratsuchi, D-Torrance. “\u003c/span>I don’t think this is a great bill, but it seems to be the best idea that we have at this point to try to improve a god-awful situation.”\u003c/p>\n\u003cp>Others worry whether it will do more harm than good, by disproportionately affecting \u003cspan style=\"font-weight: 400\">Black residents in the state, who are diagnosed with schizophrenia, on average, \u003c/span>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4274585/\">\u003cspan style=\"font-weight: 400\">three to four times more often\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> than white residents. Black residents also represent\u003c/span>\u003ca href=\"https://files.hudexchange.info/reports/published/CoC_PopSub_State_CA_2020.pdf\">\u003cspan style=\"font-weight: 400\"> 30% of those experiencing homelessness\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> in the state, but only 6.5% of the general population. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“It’s Black men, Black trans folks, Black folks in general who will be the ones who are disproportionately forced into CARE Court and disproportionately affected by this horribly myopic legislation,” said Burch, of the Anti Police-Terror Project. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The bill requires an annual report on CARE Court, along with an independent, research-based entity to evaluate the effectiveness of the program, including “through the lens of health equity” to identify racial bias. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Now that CARE Court has been signed into law, Doty Cabrera said it will be critical to keep those concerns in mind as counties try to imagine all of the program’s “unknown variables.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“This is sort of like Chapter One of a novel,” she said. “We’ll be working on this for a long time to come.”\u003c/span>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>Updated Wednesday 2 p.m.\u003c/em>\u003c/p>\n\u003cp>Gov. Gavin Newsom signed a controversial bill Wednesday overhauling the state’s approach to mental health care for people diagnosed with schizophrenia and other psychotic disorders.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The state Senate last month approved the\u003c/span> Community Assistance, Recovery and Empowerment Act, which will allow family members and first responders to ask a judge to draw up a treatment plan for people deemed to be suffering from those disorders. Those who refuse could be placed under a conservatorship and ordered to comply.\u003c/p>\n\u003cp>Currently, unhoused people with severe mental health disorders can be held against their will at psychiatric hospitals, but must be released after three days if they promise to follow up with other services and take prescribed medication.\u003c/p>\n\u003cp>The new law will let a court order a treatment plan for up to two years, which may include medication, housing and therapy.\u003cspan style=\"font-weight: 400\"> Participants will have access to a public defender and an advocate to help make decisions about treatment programs and housing. In turn, the behavioral health department in that county would be compelled to provide treatment.\u003c/span>\u003c/p>\n\u003cp>While it shares some elements of mental health programs in some other states, California’s new system will be the first of its kind in the country, according to state Sen. Tom Umberg, D-Santa Ana, who co-authored the law.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Standing outside Momentum for Health, a nonprofit mental health care provider in San José, Newsom on Wednesday said the bill was about redesigning a broken system \u003c/span>\u003cspan style=\"font-weight: 400\">that often leaves people cycling among homelessness, jail and emergency rooms. \u003c/span>\u003c/p>\n\u003cp>“I’m not interested in the status quo,” he said. “I’m not interested in the compassionless-ness of the approach we have today of people moralizing and normalizing that suffering on the streets and sidewalks.”\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But critics of the bill say it coerces people into care, which is less effective than voluntary treatment, and doesn’t provide the necessary health and housing resources.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">James Burch, deputy director of the Anti Police-Terror Project, which is part of a statewide coalition opposing CARE Court, called the bill’s signing “devastating.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“It ignores the very stark reality that we’re living in in this moment,” he said. “We are tens of thousands of beds short in the Bay Area of the permanent housing that we need. … And we are woefully short on voluntary treatment programs.”\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cspan style=\"font-weight: 400\">Gov. Gavin Newsom introduced the proposal in March. \u003c/span>It passed the Legislature with overwhelming support, despite vehement opposition from disability rights and homeless advocates.\u003c/p>\n\u003cp>“It was just a matter of months ago that we stood right here and we laid out a vision,” Newsom said Wednesday. “And here we are. We’ve made it a reality, and that is rare in politics, particularly on issues as vexing and challenging as this issue.”\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Santa Clara County Superior Court Judge Stephen Manley said every day he sees people caught in a cycle of homelessness, jail and emergency rooms, without ever getting the adequate care or housing they need. Manley oversees a \u003ca href=\"https://steinberginstitute.org/champion/stephen-v-manley/\" target=\"_blank\" rel=\"noopener noreferrer\">mental health care diversion court\u003c/a> for people awaiting trial for suspected crimes. \u003c/span>\u003c/p>\n\u003cp>“I think this is a major step towards building a system that is going to be effective, as opposed to the present system,” Manley said, “where these individuals simply cycle through our jails over to the emergency room of a hospital, back to the streets, back to the jail, back to the hospital. And it doesn’t stop.”\u003c/p>\n\u003cp>Assemblymember Suzette Martinez Valladares, R-Santa Clarita, said CARE Court was coming 10 years too late. She shared the story of her cousin, a Vietnam veteran, who was homeless and living in an encampment for five years before he died.\u003c/p>\n\u003cp>“I wish that my family had the tools that this bill is going to bring forward so that he might still be alive and with us,” she said, adding, “But there’s more work to be done. This bill is great, but we need resources for the programs, for the services, for the workforce that doesn’t currently exist.”\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The state faces a shortage of not only \u003c/span>\u003ca href=\"https://www.rand.org/pubs/research_reports/RRA1824-1-v2.html\">\u003cspan style=\"font-weight: 400\">psychiatric facilities\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, but also the \u003c/span>\u003ca href=\"https://healthforce.ucsf.edu/sites/healthforce.ucsf.edu/files/publication-pdf/California%E2%80%99s%20Current%20and%20Future%20Behavioral%20Health%20Workforce.pdf\">\u003cspan style=\"font-weight: 400\">health care staff\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> needed to operate those facilities. And Newsom’s administration estimates that between 7,000 and 12,000 people across the state will be eligible for CARE Court. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“We’re guessing there will be demand for this,” said Michelle Doty Cabrera, executive director of the County Behavioral Health Directors Association of California. “There’s not a lot of give in terms of our workforce currently.”\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The state is allocating $65 million to implement CARE Court within the judicial system, as well as additional money for county behavioral health care agencies, which would manage cases. To help pay for start-up and training costs, the first seven counties to implement CARE Court will receive $26 million, with another $31 million going to counties across the state, Doty Cabrera said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Those first seven counties are Glenn, Orange, Riverside, San Diego, Stanislaus, Tuolumne and San Francisco, which will implement CARE Courts by Oct. 1, 2023. The remaining counties would have until Dec. 1, 2024.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“And, there’s an ongoing conversation around long-term funding,” Doty Cabrera said. The bill now requires the state to provide funding to county behavioral health care agencies for programs and services before counties are required to implement CARE Court. “What that is, what it looks like, how much — all of that is still to be worked out between counties and the state,” she said.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>The other looming question is housing. \u003cspan style=\"font-weight: 400\">The current version of the bill allows judges to order other government agencies, such as housing authorities, to prioritize CARE Court participants for housing. But in more rural parts of the state, housing with the appropriate services just doesn’t exist, Doty Cabrera added. \u003c/span>\u003c/p>\n\u003cp>“Who exactly are we going to pull into the order?” she said. “No one. There is nothing.”\u003c/p>\n\u003cp>Last year, nearly 14,000 people experiencing homelessness voluntarily sought mental health services, but only half were placed into housing, according to a survey conducted earlier this year by the County Behavioral Health Directors Association of California.\u003c/p>\n\u003cp>Beyond the logistics, members of the Assembly grappled with CARE Court’s reliance on the judicial system. Although voluntary, the legislation also comes with a threat: Continued refusal could be used as a justification for conservatorship, where people could be forced into care against their will.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“At what point does compassion end and our desire to just get people off the streets and out of public sight begin?” said Assemblymember Al Muratsuchi, D-Torrance. “\u003c/span>I don’t think this is a great bill, but it seems to be the best idea that we have at this point to try to improve a god-awful situation.”\u003c/p>\n\u003cp>Others worry whether it will do more harm than good, by disproportionately affecting \u003cspan style=\"font-weight: 400\">Black residents in the state, who are diagnosed with schizophrenia, on average, \u003c/span>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4274585/\">\u003cspan style=\"font-weight: 400\">three to four times more often\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> than white residents. Black residents also represent\u003c/span>\u003ca href=\"https://files.hudexchange.info/reports/published/CoC_PopSub_State_CA_2020.pdf\">\u003cspan style=\"font-weight: 400\"> 30% of those experiencing homelessness\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> in the state, but only 6.5% of the general population. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“It’s Black men, Black trans folks, Black folks in general who will be the ones who are disproportionately forced into CARE Court and disproportionately affected by this horribly myopic legislation,” said Burch, of the Anti Police-Terror Project. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The bill requires an annual report on CARE Court, along with an independent, research-based entity to evaluate the effectiveness of the program, including “through the lens of health equity” to identify racial bias. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Now that CARE Court has been signed into law, Doty Cabrera said it will be critical to keep those concerns in mind as counties try to imagine all of the program’s “unknown variables.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“This is sort of like Chapter One of a novel,” she said. “We’ll be working on this for a long time to come.”\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>With two weeks left in the legislative session, Marisa and Guy Marzorati discuss two of the most controversial bills in the state capitol. First, KQED Labor Correspondent Farida Jhabvala-Romero joins to talk about the changes to the fast food industry proposed in Assembly Bill 257 and Jason Elliot, Senior Counselor to Governor Gavin Newsom on housing and homelessness, discusses the administration’s CARE Court proposal (Senate Bill 1338) for Californians with severe mental illness.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>With two weeks left in the legislative session, Marisa and Guy Marzorati discuss two of the most controversial bills in the state capitol. First, KQED Labor Correspondent Farida Jhabvala-Romero joins to talk about the changes to the fast food industry proposed in Assembly Bill 257 and Jason Elliot, Senior Counselor to Governor Gavin Newsom on housing and homelessness, discusses the administration’s CARE Court proposal (Senate Bill 1338) for Californians with severe mental illness.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>In early March, Gov. Gavin Newsom unveiled a controversial proposal to compel people with serious mental health issues into care and housing.\u003c/p>\n\u003cp>Mental health advocates, mayors and family members who stood alongside him at the press conference at a San José behavioral health treatment program heralded the plan, known as CARE Court, as a visionary move.\u003c/p>\n\u003cp>But some county officials say they were stunned.\u003c/p>\n\u003cp>“They really sprung it on everybody,” said Farah McDaid Ting, public affairs director at the California State Association of Counties, who said lawmakers didn’t consult with or even give her organization a heads-up.[pullquote size=\"medium\" align=\"right\" citation=\"Margot Kushel, director, Benioff Homelessness and Housing Initiative, Zuckerberg San Francisco General Hospital and Trauma Center\"]‘I worry if it houses some but leaves others out, are we just reshuffling things?’[/pullquote]\u003c/p>\n\u003cp>Four months later, the bill to establish CARE Court has sailed through all of its policy committees in the Legislature, secured unanimous approval from the Senate in May and is widely expected to become law later this summer. CARE Court — short for \u003ca href=\"https://www.gov.ca.gov/2022/03/03/governor-newsom-launches-new-plan-to-help-californians-struggling-with-mental-health-challenges-homelessness/\">Community Assistance, Recovery and Empowerment Court\u003c/a> — has garnered enthusiastic support from leaders of more than 45 cities, many of whom face fiery criticism over their handling of homelessness. Many family members, who for decades have felt stymied by strict eligibility rules for conservatorship, also are celebrating the new plan.\u003c/p>\n\u003cp>But county representatives continue to ring alarm bells about their ability to implement the proposal, especially as an aggressive timeline comes into focus. A handful of counties have registered support for the proposal, including Marin, Contra Costa and San Diego.\u003c/p>\n\u003cp>Many of the counties’ concerns come in the form of questions: Will the necessary housing be available? Where can they find the outreach workers and therapists needed to serve the population, given massive statewide shortages of both? What happens to all the struggling people who want housing and treatment, and already can’t get it?\u003c/p>\n\u003cp>Disability rights advocates are raising fundamental questions about the very premise of CARE Court: Is it effective to compel people into care? Is involuntary treatment a violation of their civil rights?\u003c/p>\n\u003cp>But many of those who support the concept say the more practical questions feel especially pressing right now, as the Legislature continues its deliberations. While many details are still in flux, the gist of the proposal remains the same as initially outlined. Anyone from family members to first responders could petition a civil court to create a court-ordered care plan for people who meet specific criteria.\u003c/p>\n\u003cp>These include a diagnosis of schizophrenia or other psychotic disorders, along with being at risk of harming themselves or others or being unlikely to survive on their own. Participants would receive legal counsel and a range of mental health services, medication and supportive housing. Following a series of check-ins during a yearlong period, the participant could either graduate or be referred to an additional year of treatment. If a person refuses to comply, or “fails out,” they could be considered by the court for \u003ca href=\"https://calmatters.org/justice/2021/07/britney-spears-conservatorship/\">conservatorship\u003c/a>.\u003c/p>\n\u003cp>Conversations about CARE Court have been peppered with frequent references to people living on California’s sidewalks and under its freeway overpasses. But the administration hasn’t been clear about how much of a dent the proposal would make in the state’s massive homelessness crisis. Prior to the pandemic, more than 161,000 people in the state were estimated to be homeless on any given night; that number has likely grown since. The administration says the program will serve 7,000 to 12,000 people with the most acute mental health needs. Homelessness isn’t a prerequisite to participate.[aside postID=\"news_11916040,news_11914873\" label=\"Related Posts\"]The administration also says the proposal represents a crucial step toward addressing one of the state’s great moral and policy failings: the vast ranks of unhoused people languishing with serious mental illness and without care.\u003c/p>\n\u003cp>“What CARE Court is saying is we must create a pathway wherein these individuals that live in the shadows and often die in the shadows become a priority group,” said Dr. Mark Ghaly, secretary of the California Health and Human Services Agency, who has been championing the program on behalf of the Newsom administration.\u003c/p>\n\u003cp>CARE Court’s supporters say no more time can be wasted. Judge Stephen Manley, who started the state’s first mental health court in Santa Clara County nearly 25 years ago, notes the growing percentage of people in local jails and prisons with serious mental illnesses. Only by mandating that counties prioritize this population, he said, will anything change.\u003c/p>\n\u003cp>“People are always telling me it can’t be done,” he said. “To me it is a tragedy that we repeatedly, year after year after year after year, talk about this issue, do nothing, and all these individuals end up in the criminal justice system.”\u003c/p>\n\u003ch2>Is there enough housing or will there be?\u003c/h2>\n\u003cp>Perhaps the most prominent question that has emerged among legislators and advocates is whether there is enough housing available to get the CARE Court program started.\u003c/p>\n\u003cp>Short answer: No.\u003c/p>\n\u003cp>But the state believes that bringing CARE Court participants to the front of the line, along with making unprecedented investments in housing this year, will allow counties to meet the needs of this population. Opponents fear others awaiting voluntary services will be bumped to the back of the line, leaving their needs to intensify.\u003c/p>\n\u003cp>“I worry if it houses some but leaves others out, are we just reshuffling things?” said Margot Kushel, director of the Benioff Homelessness and Housing Initiative at Zuckerberg San Francisco General Hospital and Trauma Center.\u003c/p>\n\u003cp>While the new budget deal includes $65 million this year and $49 million in ongoing annual funding to cover training, court costs and legal representation, counties say the proposal doesn’t include any new funding for housing or services.\u003c/p>\n\u003cp>“There’s a new door being built onto a small house,” Ting said. “There’s no square footage, there’s no nothing, just a new door. That’s what’s kind of frustrating about the premise.”\u003c/p>\n\u003cp>The administration points skeptics to a $14 billion multiyear homelessness budget put together before the proposal’s announcement — which includes about $5 billion to build thousands of mental health treatment beds and homeless housing. This year’s budget includes $1.5 billion for interim treatment beds to hold patients over while permanent units come online. In response to counties’ concerns that even the bridge beds won’t be ready in time, the bill’s authors recently said counties would be phased into the program over two years, starting in July 2023.\u003c/p>\n\u003cp>Sen. Susan Talamantes Eggman, the bill’s co-author and a Stockton Democrat, says she believes counties are unhappy with the proposal because it finally holds them to account. It requires that they provide the care and housing a participant needs and, if they don’t, face court fines of $1,000 per day. The money, collected by the state treasury, would eventually fund local services for the people CARE Court targets.\u003c/p>\n\u003cp>“We’re not just saying the person has the obligation to accept, we’re saying the system has the obligation to treat,” Eggman said during a recent hearing.\u003c/p>\n\u003cp>Counties counter that these penalties will only take away from their already limited resources to treat people.\u003c/p>\n\u003cp>While the bill says a county has to provide services during the program, courts can’t enforce a participant’s post-graduation plans. Advocates worry that without guaranteed housing, people will wind up back on the streets, in emergency rooms and county jails.\u003c/p>\n\u003cp>“We’re going to release them back into the streets but we expect them to continue to adhere to the care plan and continue to be taking medication,” said Shonique Williams, a statewide organizer for Dignity and Power Now, who opposes the proposal. “But they’re going back into survival mode.”\u003c/p>\n\u003cp>The state doesn’t keep any sort of waitlist or even a count of treatment beds and housing that’s available to people exiting homelessness. As a result, it’s impossible to gauge the exact shortage in each county.\u003c/p>\n\u003cp>But a state-commissioned report released in January found that \u003ca href=\"https://www.dhcs.ca.gov/Pages/Assessing-the-Continuum-of-Care-for-Behavioral-Health-Services-in-California.aspx\">more than 80% of counties need more mental health treatment beds and homeless housing\u003c/a>. A 2021 study from the RAND Corporation, a nonprofit think tank\u003cstrong>,\u003c/strong> showed \u003ca href=\"https://www.rand.org/pubs/research_reports/RRA1824-1-v2.html\">the state lacks 5,000 psychiatric hospital beds and another 3,000 beds at residential treatment facilities and board-and-care homes\u003c/a>. The shortage is most pronounced in the San Joaquin Valley and for patients with additional medical needs.\u003c/p>\n\u003cp>Michelle Doty Cabrera, executive director of the California Behavioral Health Directors Association, said one recent survey showed counties had 14,000 unhoused individuals with serious mental illnesses voluntarily participating in full service partnership programs. But they couldn’t find housing for more than half of these individuals, in part because many were screened out for reasons related to their mental health conditions, she said.\u003c/p>\n\u003cp>In Sacramento County, beds are increasingly rare at board-and-care facilities, where residents receive housing, 24-hour care and three daily meals.\u003c/p>\n\u003cp>“It is a needle in a haystack right now,” said Terry Fiscus, a behavioral health worker at Turning Point, which contracts with the county.\u003c/p>\n\u003cp>The less calm and rule-abiding the patient, the less chance they have of getting or keeping a spot, he said. On top of that, \u003ca href=\"https://calmatters.org/projects/board-and-care-homes-closing-in-california-mental-health-crisis/\">facilities have been closing at a rapid clip\u003c/a> as housing prices soar and government-set reimbursement rates remain stagnant.\u003c/p>\n\u003cp>“There are a lot of people that want to come in all the time. We cannot take them,” said Jeanny Leung, who runs a board-and-care home in Sacramento.\u003c/p>\n\u003cfigure id=\"attachment_11919832\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/07/Screen-Shot-2022-07-18-at-4.32.06-PM.png\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11919832\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/07/Screen-Shot-2022-07-18-at-4.32.06-PM-800x526.png\" alt=\"A woman wearing a purple/pink shirt with designs stands outside with bushes behind her.\" width=\"800\" height=\"526\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/07/Screen-Shot-2022-07-18-at-4.32.06-PM-800x526.png 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/07/Screen-Shot-2022-07-18-at-4.32.06-PM-1020x671.png 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/07/Screen-Shot-2022-07-18-at-4.32.06-PM-160x105.png 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/07/Screen-Shot-2022-07-18-at-4.32.06-PM-1536x1011.png 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/07/Screen-Shot-2022-07-18-at-4.32.06-PM.png 1544w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Jeanny Leung outside Praise Care Home in Sacramento on Thursday, June 23, 2022. \u003ccite>(Nina Riggio/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch2>‘Squeezing blood from a turnip’\u003c/h2>\n\u003cp>Housing isn’t the only big concern counties are raising. To run, CARE Court requires staff and resources.\u003c/p>\n\u003cp>Some counties say they fear that, without new funding, the program will end up draining resources from other populations, potentially including children and youth.\u003c/p>\n\u003cp>Cabrera, of the California Behavioral Health Directors Association, uses phrases like “squeezing blood from a turnip” and “robbing Peter to pay Paul.”\u003c/p>\n\u003cp>“We’re at our limit in terms of what we can do,” she said. “We need more resources to do more.”\u003c/p>\n\u003cp>The proposal’s proponents argue that there’s plenty of money to get things up and running. They say county mental health systems have had a huge influx of taxpayer dollars in the past two years, thanks to the Mental Health Services Act, a 1% tax on incomes over $1 million that was enacted in 2004.\u003c/p>\n\u003cp>“Our millionaires in California seem to be doing very well for themselves,” said Karen Larsen, CEO of the Steinberg Institute, a nonprofit focusing on mental health policy, which supports the proposal. She notes that revenues from the tax have hit historic highs — they were at more than $4 billion this past year.\u003c/p>\n\u003cp>For two decades prior to assuming her current role, Larsen served as director of Yolo County’s Health and Human Services Agency. She believes counties can afford the costs of the new program.\u003c/p>\n\u003cp>“If they can prove they don’t have enough resources, I’d love to see it,” she said.\u003c/p>\n\u003cp>Phebe Bell, Nevada County’s behavioral health director, said she was indeed able to tap the influx of Mental Health Services Act funding to purchase a new house, providing beds for six people who were unhoused. But strict rules often limit what that pot of money can be used for, she said.\u003c/p>\n\u003cp>If the county has to pivot to focus on CARE Court mandates, she worries about who won’t be served.\u003c/p>\n\u003cp>“Many of our people are only stable because we have someone coming twice a day to deliver their meds and check in with them and make sure their furniture is upright,” she said.\u003c/p>\n\u003cp>When her county examined their full service partnership program, they found that more than a third of the 78 people in their program at any given moment were inadequately housed, with many sleeping on the streets.\u003c/p>\n\u003cp>“I don’t have a single empty bed in our system of care,” she said. “Who exactly are we incorrectly prioritizing in our work right now?”\u003c/p>\n\u003cp>Both sides agree on one specific challenge: a massive shortage of mental health providers.\u003c/p>\n\u003cp>At the beginning of the pandemic, many counties worried they’d face significant shortfalls and preemptively laid off mental health workers.\u003c/p>\n\u003cp>Now, as need surges, staffing has simply not kept pace. Counties are finding themselves losing bidding wars for therapists being courted by everyone from school districts to telehealth start-ups to major providers like Kaiser. Burnout is driving others from the field entirely.\u003c/p>\n\u003cp>Some counties now face vacancy rates of 30% to 40% in their behavioral health workforce, and many of the nonprofits they contract with are in the same situation, Larsen said.\u003c/p>\n\u003cp>“I think it’s the biggest issue we face in mental health and substance use right now,” she said.\u003c/p>\n\u003cp>This year’s budget includes $1.5 billion to build out the state’s entire health care workforce, including hundreds of millions that target behavioral health.\u003c/p>\n\u003cp>The state’s public guardians and conservators also have eyed the CARE Court proposal warily. While they are not officially affected by the proposal, they say they expect the program could lead to a surge in new referrals.\u003c/p>\n\u003cp>The programs are already severely underfunded and understaffed, said Scarlet Hughes, executive director of the California State Association of Public Administrators, Public Guardians, and Public Conservators. Right now, caseloads hover at 65 to 85 individuals per caseworker, though in some counties they’re as high as 135. That translates into visiting a client every three or four months, she said.\u003c/p>\n\u003cp>“Any impact to our members is going to be significant because they’re underwater already,” she said.\u003c/p>\n\u003ch2>What’s next?\u003c/h2>\n\u003cp>Questions over implementation, in addition to the ongoing debate over civil liberties, have been woven through CARE Court’s journey from the start. That hasn’t stopped the Legislature from voting overwhelmingly in the bill’s favor. It is expected to easily clear its final hurdles: an appropriations vote later this summer, a floor-wide vote in the Assembly and a signature from the author, the governor himself.\u003c/p>\n\u003cp>But despite their ongoing questions, counties have conceded that CARE Court is coming whether they like it or not. They know they’re not likely getting any more money for housing and staffing. For now, they’re using the appropriations process to \u003ca href=\"https://www.counties.org/sites/main/files/file-attachments/sb_1338_joint_concerns_asm_approps_letter_7-13-22.pdf?1657743565\">petition for more time and tools\u003c/a> to implement the program.\u003c/p>\n\u003cp>The administration acknowledges that counties around the state face severe shortages. But it remains committed to the idea of a better way to serve the people who are struggling the most.\u003c/p>\n\u003cp>“California has done this before,” Ghaly said. “We’ve stepped up for the most vulnerable, the most overlooked many, many times. And we can do it again.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"excerpt": "While lawmakers are still enthusiastic about Gov. Gavin Newsom's CARE Court, county officials are worried they don't have the resources to implement the idea.",
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"title": "County Officials Are Skeptical Over Gov. Newsom's CARE Court Program | KQED",
"description": "While lawmakers are still enthusiastic about Gov. Gavin Newsom's CARE Court, county officials are worried they don't have the resources to implement the idea.",
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"headline": "County Officials Are Skeptical Over Gov. Newsom's CARE Court Program",
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"nprByline": "\u003ca href=\"https://calmatters.org/author/jocelyn-wiener/\">Jocelyn Wiener\u003c/a> and \u003ca href=\"https://calmatters.org/author/manuela-tobias/\">Manuela Tobias\u003c/a>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>In early March, Gov. Gavin Newsom unveiled a controversial proposal to compel people with serious mental health issues into care and housing.\u003c/p>\n\u003cp>Mental health advocates, mayors and family members who stood alongside him at the press conference at a San José behavioral health treatment program heralded the plan, known as CARE Court, as a visionary move.\u003c/p>\n\u003cp>But some county officials say they were stunned.\u003c/p>\n\u003cp>“They really sprung it on everybody,” said Farah McDaid Ting, public affairs director at the California State Association of Counties, who said lawmakers didn’t consult with or even give her organization a heads-up.\u003c/p>\u003c/div>",
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"content": "‘I worry if it houses some but leaves others out, are we just reshuffling things?’",
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"citation": "Margot Kushel, director, Benioff Homelessness and Housing Initiative, Zuckerberg San Francisco General Hospital and Trauma Center",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Four months later, the bill to establish CARE Court has sailed through all of its policy committees in the Legislature, secured unanimous approval from the Senate in May and is widely expected to become law later this summer. CARE Court — short for \u003ca href=\"https://www.gov.ca.gov/2022/03/03/governor-newsom-launches-new-plan-to-help-californians-struggling-with-mental-health-challenges-homelessness/\">Community Assistance, Recovery and Empowerment Court\u003c/a> — has garnered enthusiastic support from leaders of more than 45 cities, many of whom face fiery criticism over their handling of homelessness. Many family members, who for decades have felt stymied by strict eligibility rules for conservatorship, also are celebrating the new plan.\u003c/p>\n\u003cp>But county representatives continue to ring alarm bells about their ability to implement the proposal, especially as an aggressive timeline comes into focus. A handful of counties have registered support for the proposal, including Marin, Contra Costa and San Diego.\u003c/p>\n\u003cp>Many of the counties’ concerns come in the form of questions: Will the necessary housing be available? Where can they find the outreach workers and therapists needed to serve the population, given massive statewide shortages of both? What happens to all the struggling people who want housing and treatment, and already can’t get it?\u003c/p>\n\u003cp>Disability rights advocates are raising fundamental questions about the very premise of CARE Court: Is it effective to compel people into care? Is involuntary treatment a violation of their civil rights?\u003c/p>\n\u003cp>But many of those who support the concept say the more practical questions feel especially pressing right now, as the Legislature continues its deliberations. While many details are still in flux, the gist of the proposal remains the same as initially outlined. Anyone from family members to first responders could petition a civil court to create a court-ordered care plan for people who meet specific criteria.\u003c/p>\n\u003cp>These include a diagnosis of schizophrenia or other psychotic disorders, along with being at risk of harming themselves or others or being unlikely to survive on their own. Participants would receive legal counsel and a range of mental health services, medication and supportive housing. Following a series of check-ins during a yearlong period, the participant could either graduate or be referred to an additional year of treatment. If a person refuses to comply, or “fails out,” they could be considered by the court for \u003ca href=\"https://calmatters.org/justice/2021/07/britney-spears-conservatorship/\">conservatorship\u003c/a>.\u003c/p>\n\u003cp>Conversations about CARE Court have been peppered with frequent references to people living on California’s sidewalks and under its freeway overpasses. But the administration hasn’t been clear about how much of a dent the proposal would make in the state’s massive homelessness crisis. Prior to the pandemic, more than 161,000 people in the state were estimated to be homeless on any given night; that number has likely grown since. The administration says the program will serve 7,000 to 12,000 people with the most acute mental health needs. Homelessness isn’t a prerequisite to participate.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>The administration also says the proposal represents a crucial step toward addressing one of the state’s great moral and policy failings: the vast ranks of unhoused people languishing with serious mental illness and without care.\u003c/p>\n\u003cp>“What CARE Court is saying is we must create a pathway wherein these individuals that live in the shadows and often die in the shadows become a priority group,” said Dr. Mark Ghaly, secretary of the California Health and Human Services Agency, who has been championing the program on behalf of the Newsom administration.\u003c/p>\n\u003cp>CARE Court’s supporters say no more time can be wasted. Judge Stephen Manley, who started the state’s first mental health court in Santa Clara County nearly 25 years ago, notes the growing percentage of people in local jails and prisons with serious mental illnesses. Only by mandating that counties prioritize this population, he said, will anything change.\u003c/p>\n\u003cp>“People are always telling me it can’t be done,” he said. “To me it is a tragedy that we repeatedly, year after year after year after year, talk about this issue, do nothing, and all these individuals end up in the criminal justice system.”\u003c/p>\n\u003ch2>Is there enough housing or will there be?\u003c/h2>\n\u003cp>Perhaps the most prominent question that has emerged among legislators and advocates is whether there is enough housing available to get the CARE Court program started.\u003c/p>\n\u003cp>Short answer: No.\u003c/p>\n\u003cp>But the state believes that bringing CARE Court participants to the front of the line, along with making unprecedented investments in housing this year, will allow counties to meet the needs of this population. Opponents fear others awaiting voluntary services will be bumped to the back of the line, leaving their needs to intensify.\u003c/p>\n\u003cp>“I worry if it houses some but leaves others out, are we just reshuffling things?” said Margot Kushel, director of the Benioff Homelessness and Housing Initiative at Zuckerberg San Francisco General Hospital and Trauma Center.\u003c/p>\n\u003cp>While the new budget deal includes $65 million this year and $49 million in ongoing annual funding to cover training, court costs and legal representation, counties say the proposal doesn’t include any new funding for housing or services.\u003c/p>\n\u003cp>“There’s a new door being built onto a small house,” Ting said. “There’s no square footage, there’s no nothing, just a new door. That’s what’s kind of frustrating about the premise.”\u003c/p>\n\u003cp>The administration points skeptics to a $14 billion multiyear homelessness budget put together before the proposal’s announcement — which includes about $5 billion to build thousands of mental health treatment beds and homeless housing. This year’s budget includes $1.5 billion for interim treatment beds to hold patients over while permanent units come online. In response to counties’ concerns that even the bridge beds won’t be ready in time, the bill’s authors recently said counties would be phased into the program over two years, starting in July 2023.\u003c/p>\n\u003cp>Sen. Susan Talamantes Eggman, the bill’s co-author and a Stockton Democrat, says she believes counties are unhappy with the proposal because it finally holds them to account. It requires that they provide the care and housing a participant needs and, if they don’t, face court fines of $1,000 per day. The money, collected by the state treasury, would eventually fund local services for the people CARE Court targets.\u003c/p>\n\u003cp>“We’re not just saying the person has the obligation to accept, we’re saying the system has the obligation to treat,” Eggman said during a recent hearing.\u003c/p>\n\u003cp>Counties counter that these penalties will only take away from their already limited resources to treat people.\u003c/p>\n\u003cp>While the bill says a county has to provide services during the program, courts can’t enforce a participant’s post-graduation plans. Advocates worry that without guaranteed housing, people will wind up back on the streets, in emergency rooms and county jails.\u003c/p>\n\u003cp>“We’re going to release them back into the streets but we expect them to continue to adhere to the care plan and continue to be taking medication,” said Shonique Williams, a statewide organizer for Dignity and Power Now, who opposes the proposal. “But they’re going back into survival mode.”\u003c/p>\n\u003cp>The state doesn’t keep any sort of waitlist or even a count of treatment beds and housing that’s available to people exiting homelessness. As a result, it’s impossible to gauge the exact shortage in each county.\u003c/p>\n\u003cp>But a state-commissioned report released in January found that \u003ca href=\"https://www.dhcs.ca.gov/Pages/Assessing-the-Continuum-of-Care-for-Behavioral-Health-Services-in-California.aspx\">more than 80% of counties need more mental health treatment beds and homeless housing\u003c/a>. A 2021 study from the RAND Corporation, a nonprofit think tank\u003cstrong>,\u003c/strong> showed \u003ca href=\"https://www.rand.org/pubs/research_reports/RRA1824-1-v2.html\">the state lacks 5,000 psychiatric hospital beds and another 3,000 beds at residential treatment facilities and board-and-care homes\u003c/a>. The shortage is most pronounced in the San Joaquin Valley and for patients with additional medical needs.\u003c/p>\n\u003cp>Michelle Doty Cabrera, executive director of the California Behavioral Health Directors Association, said one recent survey showed counties had 14,000 unhoused individuals with serious mental illnesses voluntarily participating in full service partnership programs. But they couldn’t find housing for more than half of these individuals, in part because many were screened out for reasons related to their mental health conditions, she said.\u003c/p>\n\u003cp>In Sacramento County, beds are increasingly rare at board-and-care facilities, where residents receive housing, 24-hour care and three daily meals.\u003c/p>\n\u003cp>“It is a needle in a haystack right now,” said Terry Fiscus, a behavioral health worker at Turning Point, which contracts with the county.\u003c/p>\n\u003cp>The less calm and rule-abiding the patient, the less chance they have of getting or keeping a spot, he said. On top of that, \u003ca href=\"https://calmatters.org/projects/board-and-care-homes-closing-in-california-mental-health-crisis/\">facilities have been closing at a rapid clip\u003c/a> as housing prices soar and government-set reimbursement rates remain stagnant.\u003c/p>\n\u003cp>“There are a lot of people that want to come in all the time. We cannot take them,” said Jeanny Leung, who runs a board-and-care home in Sacramento.\u003c/p>\n\u003cfigure id=\"attachment_11919832\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/07/Screen-Shot-2022-07-18-at-4.32.06-PM.png\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11919832\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/07/Screen-Shot-2022-07-18-at-4.32.06-PM-800x526.png\" alt=\"A woman wearing a purple/pink shirt with designs stands outside with bushes behind her.\" width=\"800\" height=\"526\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/07/Screen-Shot-2022-07-18-at-4.32.06-PM-800x526.png 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/07/Screen-Shot-2022-07-18-at-4.32.06-PM-1020x671.png 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/07/Screen-Shot-2022-07-18-at-4.32.06-PM-160x105.png 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/07/Screen-Shot-2022-07-18-at-4.32.06-PM-1536x1011.png 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/07/Screen-Shot-2022-07-18-at-4.32.06-PM.png 1544w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Jeanny Leung outside Praise Care Home in Sacramento on Thursday, June 23, 2022. \u003ccite>(Nina Riggio/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch2>‘Squeezing blood from a turnip’\u003c/h2>\n\u003cp>Housing isn’t the only big concern counties are raising. To run, CARE Court requires staff and resources.\u003c/p>\n\u003cp>Some counties say they fear that, without new funding, the program will end up draining resources from other populations, potentially including children and youth.\u003c/p>\n\u003cp>Cabrera, of the California Behavioral Health Directors Association, uses phrases like “squeezing blood from a turnip” and “robbing Peter to pay Paul.”\u003c/p>\n\u003cp>“We’re at our limit in terms of what we can do,” she said. “We need more resources to do more.”\u003c/p>\n\u003cp>The proposal’s proponents argue that there’s plenty of money to get things up and running. They say county mental health systems have had a huge influx of taxpayer dollars in the past two years, thanks to the Mental Health Services Act, a 1% tax on incomes over $1 million that was enacted in 2004.\u003c/p>\n\u003cp>“Our millionaires in California seem to be doing very well for themselves,” said Karen Larsen, CEO of the Steinberg Institute, a nonprofit focusing on mental health policy, which supports the proposal. She notes that revenues from the tax have hit historic highs — they were at more than $4 billion this past year.\u003c/p>\n\u003cp>For two decades prior to assuming her current role, Larsen served as director of Yolo County’s Health and Human Services Agency. She believes counties can afford the costs of the new program.\u003c/p>\n\u003cp>“If they can prove they don’t have enough resources, I’d love to see it,” she said.\u003c/p>\n\u003cp>Phebe Bell, Nevada County’s behavioral health director, said she was indeed able to tap the influx of Mental Health Services Act funding to purchase a new house, providing beds for six people who were unhoused. But strict rules often limit what that pot of money can be used for, she said.\u003c/p>\n\u003cp>If the county has to pivot to focus on CARE Court mandates, she worries about who won’t be served.\u003c/p>\n\u003cp>“Many of our people are only stable because we have someone coming twice a day to deliver their meds and check in with them and make sure their furniture is upright,” she said.\u003c/p>\n\u003cp>When her county examined their full service partnership program, they found that more than a third of the 78 people in their program at any given moment were inadequately housed, with many sleeping on the streets.\u003c/p>\n\u003cp>“I don’t have a single empty bed in our system of care,” she said. “Who exactly are we incorrectly prioritizing in our work right now?”\u003c/p>\n\u003cp>Both sides agree on one specific challenge: a massive shortage of mental health providers.\u003c/p>\n\u003cp>At the beginning of the pandemic, many counties worried they’d face significant shortfalls and preemptively laid off mental health workers.\u003c/p>\n\u003cp>Now, as need surges, staffing has simply not kept pace. Counties are finding themselves losing bidding wars for therapists being courted by everyone from school districts to telehealth start-ups to major providers like Kaiser. Burnout is driving others from the field entirely.\u003c/p>\n\u003cp>Some counties now face vacancy rates of 30% to 40% in their behavioral health workforce, and many of the nonprofits they contract with are in the same situation, Larsen said.\u003c/p>\n\u003cp>“I think it’s the biggest issue we face in mental health and substance use right now,” she said.\u003c/p>\n\u003cp>This year’s budget includes $1.5 billion to build out the state’s entire health care workforce, including hundreds of millions that target behavioral health.\u003c/p>\n\u003cp>The state’s public guardians and conservators also have eyed the CARE Court proposal warily. While they are not officially affected by the proposal, they say they expect the program could lead to a surge in new referrals.\u003c/p>\n\u003cp>The programs are already severely underfunded and understaffed, said Scarlet Hughes, executive director of the California State Association of Public Administrators, Public Guardians, and Public Conservators. Right now, caseloads hover at 65 to 85 individuals per caseworker, though in some counties they’re as high as 135. That translates into visiting a client every three or four months, she said.\u003c/p>\n\u003cp>“Any impact to our members is going to be significant because they’re underwater already,” she said.\u003c/p>\n\u003ch2>What’s next?\u003c/h2>\n\u003cp>Questions over implementation, in addition to the ongoing debate over civil liberties, have been woven through CARE Court’s journey from the start. That hasn’t stopped the Legislature from voting overwhelmingly in the bill’s favor. It is expected to easily clear its final hurdles: an appropriations vote later this summer, a floor-wide vote in the Assembly and a signature from the author, the governor himself.\u003c/p>\n\u003cp>But despite their ongoing questions, counties have conceded that CARE Court is coming whether they like it or not. They know they’re not likely getting any more money for housing and staffing. For now, they’re using the appropriations process to \u003ca href=\"https://www.counties.org/sites/main/files/file-attachments/sb_1338_joint_concerns_asm_approps_letter_7-13-22.pdf?1657743565\">petition for more time and tools\u003c/a> to implement the program.\u003c/p>\n\u003cp>The administration acknowledges that counties around the state face severe shortages. But it remains committed to the idea of a better way to serve the people who are struggling the most.\u003c/p>\n\u003cp>“California has done this before,” Ghaly said. “We’ve stepped up for the most vulnerable, the most overlooked many, many times. And we can do it again.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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